Cold Protocol

Steven Kornweiss, MD protocols Leave a Comment

Diagnosis First

Before you start the cold protocol, you need to have the right diagnosis. A “cold,” is the lay-term for a viral upper-respiratory infection. Each of these terms in the diagnosis is operative. “Viral” means that the infecting agent is a virus, as opposed to a bacteria. The significance of this is that viruses cannot be killed by antibiotics, which only kill bacteria. The viruses that cause colds are cleared by your immune system. The immune system does learn how to defend against viruses to which it’s been exposed, but colds can be caused by many different virus types and species, each of which has potentially unlimited subtypes, which is why we keep getting colds even as adults.

“Upper-respiratory,” refers to the location of the infection. The upper respiratory tract includes everything proximal to the trachea – this includes the nose and the sinuses. The throat can sometimes become inflamed due to its proximity. The primary site of infection for a cold is the nasopharynx – the nose and the structures just behind it.

The diagnosis of a cold is made clinically – this means based on signs and symptoms as opposed to by “tests.” The primary symptoms include a runny nose and nasal/sinus congestion. These are the primary symptoms because it is the nasal and sinus mucosa that is infected by the virus. These cells react with an inflammatory response, part of which is to secrete excess mucous. Secondary symptoms include headache, sore throat, cough, and fever. The headache is generally induced by sinus congestion and inflammation, the sore throat by post-nasal drip which causes an inflammatory response in the throat, the cough by irritation of the upper airway from post-nasal-drip, and the fever by a systemic immune response to the viral infection. In healthy adults, measurable fevers are unusual in response to plain colds, so a fever (measured temperature over 100 degrees F) might be a tip-off that you have something more than just a cold.

When is it likely more than a cold? Though cough and sore throat can occur from a cold, they should be minimal. A very sore throat, especially if this is the primary symptom is potentially indicative of a pharyngitis (strep throat, mono, viral pharyngitis, etc.). A persistent productive cough with wheeze and/or shortness of breath is indicative of bronchitis or pneumonia, both of which can be viral or bacterial. A severe headache, especially if this is the primary symptom or is accompanied by fever, confusion, or lethargy, is concerning for meningitis or encephalitis, though both of these are rare in comparison.

The Protocol

The following 3 actions might be most useful at the first sign of cold symptoms:

  1. Zinc – These specific Zinc Lozenges can be used as directed on the bottle. More info on Zinc Lozenges from Chris Masterjohn, Ph.D.: How to Kill a Cold with Zinc, Zinc Lozenges work for Colds but Only the Right Kind
  2. Hydrate – 2L of isotonic liquid daily. Soup, salty bone broth, or oral-rehydration solutions are ideal. Plain water, juice, and soda are not.
  3. Sleep – If there is any chance of getting additional sleep, this is extremely important. Sleep deprivation is one of the biggest insults you can deliver to your immune system, whereas the inverse is a potential boon.

Runny Nose

The zinc lozenges will likely help a lot with this, but if it’s not eliminated, these are the other treatments that I have found most useful:


The most effective decongestant in my personal experience is pseudoephedrine. This can be purchased at the pharmacy, but it is kept behind the counter. You need to ask the pharmacist. For most people, the extended release 120mg tablets will get you through the entire day if taken in the morning. Pseudoephedrine works by constricting small blood vessels in the mucous membranes and therefore decrease swelling and running of the nose. Note: It is a stimulant and can increase your heart rate, blood pressure, and may make you slightly manic. I have not had these side effects with the extended release formulation, nor have my clients. But, it is possible.

Warnings: Do not take this at night. It will keep you awake. and do not take them if you have any history of a heart condition, palpitations, or problems with a high heart-rate. Also do not drink excessive amounts of caffeine when taking this medication. If you are used to drinking 1 or 2 cups of coffee or tea per day, my experience tells me that this is likely still safe, but I would highly caution against taking any energy drinks or other stimulants at the same time as using this medication. Though unlikely, in the worst case scenario, this could kill you by creating a fatal heart arrhythmia.


Fluticasone is also a nasal decongestant that works in a different way. This medication comes as a nasal spray and is sprayed into the nares (nostrils). This medication works by blocking the formation of molecules in the inflammatory cascade and also by constricting small blood vessels. This medication has been shown to produce a decrease in the severity of runny nose, sore throat, and cough, but possibly an increase in total symptom duration.

Warnings: This is really a low-risk medication. I’m unaware of any significant side-effects other than possible prolongation of cold infection as mentioned above, and perhaps an allergic reaction, which can occur with any medication.

Sinus Congestion


A hot steamy shower with deep nasal-breathing has the ability to soften nasal and sinus secretions by humidifying them. The more liquid these secretions can become, the more likely they are to flow out, as opposed to becoming concreted within the sinuses. Ensuring > 45% humidity in your bedroom or home may be helpful too, as well as #2 above, hydration.


Experiment with sleeping position. Sleeping slightly elevated on your back, as opposed to flat and on your side or flat on your stomach may promote better sinus drainage. This isn’t a guarantee, and everyone’s anatomy, and sleeping preferences vary a little bit, so experiment with your sleeping position, especially your head position.


Through a cruel trick of anatomy, the sinuses drain only through holes that are positioned like the overflow drain of a bathtub or sink. The sinus has to fill up to a certain extent before it can drain properly, especially when inflamed or congested. This means that fluids can readily pool in the sinuses, and if they are thick, the cilia (little hair-like projections from the sinus mucosal surface) will be unable to push the mucous upwards towards the drainage hole. To get the sinuses to drain, therefore, you need to position these holes at the bottom. This mean you need to put your head into some odd positions. I recommend trying all 4 positions described below:

By Henry Vandyke Carter – Henry Gray (1918) Anatomy of the Human Body (See “Book” section below) Gray’s Anatomy, Plate 856, Public Domain,
  1. Lay on your stomach with your head hanging downwards off the edge of your bed – turn head 45-90 degrees to the left and stay for 1 minute.
  2. Then turn to the right and stay for one minute. If you feel a position that seems to relieve pressure, stay in that position longer. You may feel drainage, or you may not.
  3. Lay on your back and repeat. Let your head hang backwards off the edge of the bed and rotate left.
  4. Then rotate right, holding each position for at least 1 minute.
  5. If you’ve spent the day in bed, stand upright to drain the frontal and ethmoid sinuses.

Blowing Your Nose

The article below was written in 1915 by Harrison Griffin, MD and is entertaining as a period piece but is also informative in the proper method of blowing one’s nose. In essence, Dr. Griffin describes what I have discovered on my own – blowing one’s nose can be done incorrectly. The correct way to blow the nose is to obstruct the mouth and only one nostril at a time, and then to make a forceful exhalation through the open nostril. The force should be limited so that the pressure is directed outwards of an unobstructed nostril. If the pressure is too great, or the bilateral nostrils are occluded simultaneously, the air flow from the forced expiration will be directed into the eustachian tubes (tubes that connect the back of the throat to the middle ear) and to the sinuses. This will deliver infected mucous to the sinuses and middle ears, causing ear infections, sinus infections, and creating a reservoir for your infection, and prolonging symptoms. Blow your nose properly and avoid these problems.

Sore Throat


Benzocaine is a topical anesthetic. There many different lozenges available, but the type that gives the most immediate and complete relief from a painful sore throat are benzocaine lozenges. These essentially eliminate pain within seconds and last approximately 20 minutes. The one downside is that they become toxic in high doses, so you cannot suck on these all day. But, if you need to get through a few short periods of speaking, eating, drinking, or sleeping, these will bring incredible relief. There is a limit to their use, so follow package instructions.

Tea with Lemon and Honey

I’ve not read any research on this, it’s just a personal favorite. Though, I have seen hints of research on anti-viral and anti-bacterial properties of Manuka Honey, I have not read this yet and cannot say with any certainty that it is true. That said, I have felt significantly better after drinking hot green tea brewed with a high-quality Manuka Honey and with a squeeze of lemon added at the finish.


  1. Get the right diagnosis
  2. Sleep
  3. Hydrate
  4. Zinc
  5. Fluticasone, pseudoephedrine, steam
  6. Head positioning for sinus drainage
  7. Proper nose blowing
  8. Benzocaine lozenges
  9. Tea with lemon and honey

If you want a more detailed personalized protocol:


  1. Gwaltney, Jack M., J. Owen Hendley, C. Douglas Phillips, Cameron R. Bass, Niels Mygind, and Birgit Winther. “Nose Blowing Propels Nasal Fluid into the Paranasal Sinuses.” Clinical Infectious Diseases 30, no. 2 (February 1, 2000): 387–91.
  2. “The Common Cold: Effects of Intranasal Fluticasone Propionate Treatment – Journal of Allergy and Clinical Immunology.” Accessed February 6, 2020.

Library: I maintain a research library of the studies I review for my posts. Here is a link to the relevant resources that this post is based upon, and more.

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